When assessing a child after heart surgery to correct Tetralogy of Fallot (TOP) which finding should alert the nurse to suspect a le carat output?
Altered level of consciousness and treaty pulse
Bounding pulses and mottled skin
Capillary refill of 2 seconds and blood pressure of 96/47 mmHg
Extremities warm to the touch and pale skin
The Correct Answer is A
A.Altered level of consciousness and thready pulse.
In a child after heart surgery to correct Tetralogy of Fallot (TOF), a thready pulse and altered level of consciousness can be indicative of poor cardiac output. This may suggest that the heart is not effectively pumping blood to meet the body's needs.
B. Bounding pulses and mottled skin: Bounding pulses and mottled skin are not typical signs of decreased cardiac output. Bounding pulses are often associated with increased cardiac output.
C. Capillary refill of 2 seconds and blood pressure of 96/47 mmHg: A capillary refill of 2 seconds is within the normal range, and a blood pressure of 96/47 mmHg is reasonable for a child. These findings do not necessarily indicate poor cardiac output.
D. Extremities warm to the touch and pale skin: Warm extremities and pale skin are not typical signs of decreased cardiac output. Cold extremities and cyanosis may be more concerning signs.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Trientine: Trientine is a medication used to treat copper overload in conditions like Wilson's disease. It is not indicated for iron overdose or toxicity.
B. Dimercaprol: Dimercaprol, also known as BAL (British Anti-Lewisite), is a chelating agent used to treat heavy metal poisoning but is not primarily used for iron overload or toxicity.
C. Ferrous gluconate: Ferrous gluconate is an iron supplement used to treat iron-deficiency anemia by providing additional iron to the body. It is not appropriate for treating iron overdose, as it would worsen the situation.
D. Deferoxamine.
Iron overdose, also known as iron toxicity, can lead to serious complications, including cardiac dysrhythmias. Deferoxamine is a chelating agent used to remove excess iron from the body in cases of iron overload or toxicity, such as in patients with conditions like sickle cell anemia who require frequent blood transfusions. It binds to excess iron and helps excrete it from the body, reducing the risk of iron-related complications, including cardiac issues.
Correct Answer is C
Explanation
A. Neutropenic Precautions: Neutropenia refers to a low neutrophil count, a type of white blood cell responsible for fighting infections. While children with leukemia are at risk for neutropenia due to the disease and its treatment, the primary concern in this scenario is the critically low platelet count and the risk of bleeding. Neutropenic precautions focus on preventing infections.
B. Droplet Precautions: Droplet precautions are used when dealing with respiratory infections that are transmitted through respiratory droplets, such as coughing or sneezing. This is not the primary concern for a child with leukemia and a low platelet count, as the main risk is bleeding due to the low platelet count.
C. Bleeding Precautions: Leukemia, especially in a child with a critically low platelet count, puts the child at a high risk of bleeding. Platelets are essential for blood clotting, and when they are severely decreased, even minor injuries can lead to excessive bleeding. The nurse should take precautions to minimize the risk of bleeding. This includes avoiding invasive procedures, using a soft toothbrush, and ensuring that the child does not participate in activities that could result in injury.
D. Contact Precautions: Contact precautions are used to prevent the transmission of infectious diseases through direct contact. While a child with leukemia may have a weakened immune system and be at risk of infections, the primary concern in this case is the critically low platelet count and the risk of bleeding. Contact precautions are more relevant in cases of contagious diseases where physical contact could transmit the infection.
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